The Power of Proximity: Co-Locating Childcare and Eldercare Programs

Intergenerational shared sites that bring childcare and eldercare under the same roof help both generations thrive, and we need to build more of them.

By Donna M. Butts & Shannon E. Jarrott Apr. 5, 2021

(Illustration by Gracia Lam)

Intergenerational shared sites are not a new concept in the United States. Messiah Lifeways, a residential community for older adults in Mechanicsburg, Pennsylvania, opened more than 40 years ago with a childcare center and preschool on its campus. It’s still thriving today.

For years, researchers have studied care programs for children and older adults that share the same building or campus, and foster relationships across generations. Although shared sites vary widely, the most common model pairs preschools with adult day care or nursing homes. A typical day at ONEgeneration in Van Nuys, California, for example, includes older adults doing watercolor art with toddlers, holding and feeding babies in the infant room, and teaching preschoolers Mandarin or Spanish.

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Research shows that intergenerational shared sites increase the health and well-being of both young and older participants, reduce social isolation, and create cost efficiencies. They are joyful places. And unsurprisingly, the concept is a popular one; when asked, Americans are overwhelmingly in favor of shared sites. A recent Harris poll commissioned by Generations United and the Eisner Foundation found that nearly all Americans believe older adults and children have skills and talents to help one another, and that 85 percent would prefer a shared site that fosters intergenerational connection over an age-segregated facility if they or a loved one needed care.

And yet, while successful shared sites exist in countries around the world—including Japan, the United Kingdom, Canada, Australia, Spain, and Singapore—there are fewer than 150 of them in the United States, compared to tens of thousands of age-segregated care facilities around the country.

So, as one site director put it, “Why aren’t these in every community?” The answer is that this relatively simple care model, it turns out, is difficult to pull off, complicated by funding silos and cumbersome regulations. Most funders that support care facilities focus on either childcare or eldercare, forcing operators of shared sites to seek and manage separate funding sources. Furthermore, the staffing plans, emergency evacuation procedures, and other regulations that govern care sites for younger people differ from those designed for older populations.

How can advocates of shared sites, including nonprofits, community leaders, caregiving professionals, and entrepreneurs overcome these hurdles and ultimately proliferate intergenerational shared sites? After decades of visiting, studying, and advocating for intergenerational shared sites, we believe that the following four strategies can dramatically expand their number.

1. Increase Awareness of the Benefits of Shared Sites

Only 26 percent of Americans are aware of places in their community that care for children and older adults together. Introducing more people to the concept and highlighting its benefits—for younger and older adults, and those in between—will lead more people to advocate for and invest in them.

Simply making intergenerational connection more visible through the design of buildings, community engagement, and promotional materials is one way to do this. At the Grace Living Center and Jenks West Elementary intergenerational site in Jenks, Oklahoma, for example, pre-kindergarten and kindergarten classrooms are located within a skilled nursing facility—and visible from the lobby. Each morning, the “grands” welcome children as they walk to classes run and staffed by the school district. The site’s Reading Buddies program also engages older adults as tutors, and ice-cream socials and other informal activities encourage intergenerational mixing.

Another way to do this is by sharing data and stories about the positive effects on participants, which program directors and boards, advocates, and entrepreneurs can do via social media, community gatherings, campaigns, and pitches for project funding. For example, research shows that older adults in shared sites feel more accomplished, improve cognitively and physically, and find new purpose in their daily lives. Meanwhile, children thrive under the extra attention they receive, while learning essential skills like patience and tolerance. “I get calls from teachers after our kids graduate and go on to grade school,” said Keith Leiderman, CEO of the shared adult day care Kingsley House in New Orleans, Louisiana, “and they say our kids are the most compassionate, empathetic, and accepting children, who don’t think twice about being friends with kids with disabilities.”

Shared sites benefit and build the health-care workforce as well. Geriatric Career Development Program at New Jewish Home, a long-term care facility in New York, operates a high-school program that has graduated nearly 900 at-risk students. The program has not only sparked student interest in health-related careers but also helped them develop a range of useful life skills. One graduating senior said she learned “self-respect and how to respect our elders” from the program, along with the meaning of true friendship, self-improvement, and perseverance. Of the recent graduating class, 100 percent were college-bound.

Finally, attracting and retaining staff—a chronic problem in the care industry—is less of an issue at shared sites, because employees can more easily meet their own family caregiving needs, and many find joy working with both children and seniors. As Maria Nicolacoudis, executive director of a shared site in San Jose, California, called the Hearts and Minds Activity Center said, “The chance to work with both groups is why I was attracted to this job.”

2. Engage Champions and Build Community Alliances

Raising general awareness of the benefits of shared sites is important, but buy-in and support from local community members and elected officials are crucial to getting them built and maintaining their vibrancy over the longer term. A shared site that draws on the talents and resources of the local community, and that invites a range of groups to take part in its successes and tribulations will more likely prosper over the longer term.

Engaged local champions are invaluable to progress. As one example, Pam Smith, an activist and a former school board member in San Diego County, California, advocated for building a senior housing site on the grounds of a charter school in a predominately Hispanic area. Over the course of a decade, she educated fellow board members about the value of intergenerational practices and, starting with smaller programs like intergenerational gardens, demonstrated the benefits. Today, the housing site, Seniors on Broadway, and the school have an intergenerational pathway connecting them; students visit the seniors to share in art and cooking projects, and older adults walk to tutor children and enjoy activities at the school.

Elected officials may also embrace shared sites as a way of bringing jobs to communities that need them. When the St. Ann Center for Intergenerational Care built its second shared site, Bucyrus Campus, in an underserved area of Milwaukee, Wisconsin, the site’s leaders, with support from the city council, responded to feedback from local groups and residents in need of jobs by hiring the majority of site staff from the surrounding neighborhoods.

3. Find Ways to Share Resources, Including Funding

Innovation and creativity are key to efficiently using space, staff, and services in areas like dining, housekeeping, marketing, and building maintenance. But sharing funding is often the bigger challenge. Childcare and eldercare programs typically rely on fundraising and grants to fulfill their mission. But, as we mentioned at the beginning, foundations normally prioritize services for either older adults or children, requiring staff at intergenerational sites to develop separate funding proposals, and manage separate tracking and reporting systems.

There are, however, ways to make it work. When the chief executive of Grace Living Centers explored dedicating space for children at one of its facilities, for example, he partnered with the local school board. With school buildings at capacity, locating two kindergarten classes at Grace Living saved the district the expense of purchasing additional classroom space.

As another example, the shared site ONEgeneration receives state and federal funds for some of its adult care services, and its fee-for-service childcare program helps offset other costs. By sharing expenses, the organization can offer more staffing services; its eight-to-one, participant-to-staff ratio is double the state licensing requirement, and its team includes two full-time nurses, as well as part-time speech and physical therapists.

4. Encourage the Development of New Policies and Standards

As we alluded to at the beginning, shared site operators often struggle to navigate age-segregated licensing and accreditation rules. Regulations designed to protect older adults and children differ, so operators must meet multiple sets of requirements across a range of operational details, including staff-to-participant ratios and numbers of meals served. Advocates must help accrediting bodies and policy makers understand the challenges they face, and work with them to develop new, intergenerational-friendly standards.

At Benevilla, an adult day care and childcare center in Arizona, for example, the state licensing agency for childcare originally said children could only interact with the older adults in spaces outside the childcare center. So the site built a separate room specifically for young and older people to interact, and assigned it a different address so that the children could go on “field trips” to visit the older adults while still meeting regulations. Over time, as the surveyors became more familiar with the intergenerational aspects of Benevilla’s program and its benefits, they’ve worked with site leaders to make it possible for the children to visit the adult services center in small groups.

Generations United, the national advocacy organization for intergenerational programs and policies, has meanwhile worked with policy champions on Capitol Hill to prioritize shared sites. The organization shared program examples from Congressional members’ home districts and stories illustrating the positive impact on their constituents in meetings with Capitol Hill representatives and staff, during press events, and through informational materials. As a result, programs serving both young and old, and shared site programs such as co-located childcare and long-term care facilities, are priorities in the unanimously reauthorized Older Americans Act.

A Call to Action

The COVID-19 pandemic brought to light the isolation of many residents at traditional senior care facilities and the vulnerability of childcare centers. But overall, shared-site programs appear to have fared better than single-generation facilities. In many cases, childcare centers at shared sites stayed open to serve the children of essential workers. Regular playdates between generations carried over to video, and outdoor, socially distanced visits between young and old helped reduce loneliness.

The scarcity of shared sites is a big loss to individuals and communities. Older adults and children in age-segregated programs miss the chance to enjoy and learn from one another. Working parents who juggle age-segregated care for children and older relatives are denied a simple one-stop solution. And at a time when there’s a growing demand for childcare and eldercare, but limited resources for new facilities, communities miss a crucial opportunity to save money by co-locating existing programs. For all these reasons, intergenerational caregiving sites must be a priority for families, caregiving professionals, policy makers, and elected officials.

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